Maternal knowledge of effective breastfeeding and its benefits, as potential determinant of attitudes to infant feeding: A survey in Calabar, Nigeria

Appropriate breastfeeding is a cost-effective child survival strategy. This study assessed relationship between knowledge of breastfeeding and attitude towards infant feeding among pregnant women in Calabar, Nigeria. By convenience sampling, consenting antenatal clinic attendees were recruited from secondary health centers in Calabar. Pre-tested questionnaire was used to assess knowledge of different aspects of breastfeeding, while the Iowa Infant Feeding Attitude Scale (IIFAS) was used to assess attitude towards infant feeding. Data was analyzed using SPSS version 21.0, with p-value of less than 0.05 considered statistically significant. Two hundred and fifty (250) pregnant women were surveyed with mean age of 29.7 ± 6.1 years. One hundred and eight respondents (43.2%) had unsatisfactory levels of knowledge. Common areas of misconception were oral thrush effect of breastfeeding (47.2%), frequency of breast milk expression (47.6%), and effects of inverted nipples (45.6%). Most respondents (92.0%) had neutral attitude to infant feeding, and there was no significant relationship between overall knowledge of breastfeeding and infant feeding attitude (p>0.05). Of all the knowledge areas assessed, only benefits to mothers (r=0.11, p=0.08) and effective breastfeeding (r=0.17, p=0.01), had knowledge scores that correlated positively with infant feeding attitude scores. These findings contribute to existing literature required for improvement in policies and strategies, for breastfeeding education and child survival, especially in resource-poor settings. There is need for further research towards improving priority content of maternal health education during the time-constrained ANC visits. Keywords: Knowledge, breastfeeding, infant feeding attitude, pregnant women, Calabar, Nigeria   L'allaitement maternel approprié est une stratégie rentable de survie de l'enfant. Cette étude a évalué la relation entre la connaissance de l'allaitement maternel et l'attitude envers l'alimentation du nourrisson chez les femmes enceintes à Calabar, au Nigéria. Par échantillonnage de convenance, les participants consentants des cliniques prénatales ont été recrutés dans les centres de santé secondaires de Calabar. Un questionnaire pré-testé a été utilisé pour évaluer les connaissances sur les différents aspects de l'allaitement maternel, tandis que l'Iowa Infant Feeding Attitude Scale (IIFAS) a été utilisé pour évaluer l'attitude envers l'alimentation du nourrisson. Les données ont été analysées à l'aide de la version 21.0 de SPSS, avec une valeur p inférieure à 0,05 considérée comme statistiquement significative. Deux cent cinquante (250) femmes enceintes ont été interrogées avec un âge moyen de 29,7 ± 6,1 ans. Cent huit répondants (43,2%) avaient des niveaux de connaissances insatisfaisants. Les points communs d'idées fausses étaient l'effet du muguet buccal de l'allaitement (47,2%), la fréquence d'expression du lait maternel (47,6%) et les effets des mamelons inversés (45,6%). La plupart des répondants (92,0%) avaient une attitude neutre à l'égard de l'alimentation du nourrisson, et il n'y avait pas de relation significative entre la connaissance globale de l'allaitement et l'attitude en matière d'alimentation du nourrisson (p> 0,05). Parmi tous les domaines de connaissances évalués, seuls les avantages pour les mères (r = 0,11, p = 0,08) et l'allaitement maternel efficace (r = 0,17, p = 0,01) présentaient des scores de connaissance qui étaient en corrélation positive avec les scores d'attitude en matière d'alimentation du nourrisson. Ces résultats contribuent à la littérature existante nécessaire pour améliorer les politiques et stratégies, pour l'éducation à l'allaitement maternel et la survie de l'enfant, en particulier dans les milieux pauvres en ressources. Des recherches supplémentaires sont nécessaires pour améliorer le contenu prioritaire de l'éducation à la santé maternelle pendant les visites prénatales limitées dans le temps. Mots-clés: Connaissances, allaitement, attitude en matière d'alimentation du nourrisson, femmes enceintes, Calabar, Nigéri

Nutritional knowledge and practice of pre-school feeding: A comparative study among mothers in slum and urban areas of Calabar, Nigeria

In many developing countries, malnutrition has remained one of the leading causes of childhood morbidity and mortality. This is particularly important for vulnerable groups, including preschool toddlers who require adequate nutrition for physical and mental stability to face the new challenge of initiation into academic life. This study was aimed at assessing and comparing knowledge and practice of preschool feeding among mothers in urban and slum areas in Calabar, Nigeria using cross-sectional study design with researcher-administered structured questionnaire. One hundred and twenty (120) subjects were surveyed, with mean maternal age of 26.5 ± 3.4 years. Subjects in slum compared with urban areas had lower levels of education (primary level: 33.3% vs. 15.0%) (p<0.05). Thirty two (32) subjects (27.1%) had inadequate nutritional knowledge of preschool feeding. Poor knowledge of body building foods was significantly commoner among slum compared with urban subjects (43.1% vs. 18.3%, p=0.00). Also, poor knowledge of adequacy of diet was significantly commoner among slum compared with urban subjects (68.9% vs. 50.0%, p=0.04). Bread and tea (51, 42.5%), Eba and soup (37, 30.8%) and rice (27, 22.5%), were the most commonly consumed breakfast, lunch and dinner, respectively. Nutritional health education and further research including the use of qualitative methods for better understanding of the reasons for dietary pattern is recommended

Trend and Causes of Maternal Mortality in a Nigerian Tertiary Hospital: A 5-year Retrospective Study (2010-2014) at the University of Calabar Teaching Hospital, Calabar, Nigeria

BACKGROUND: Maternal mortality ratios (MMR) are still unacceptably high in many low-income countries especially in sub-Saharan Africa. MMR had been reported to have improved from an initial 3,026 per 100,000 live births in 1999 to 941 in 2009, at the University of Calabar Teaching Hospital (UCTH), Calabar, a tertiary health facility in Nigeria. Post-partum haemorrhage and hypertensive diseases of pregnancy have been the common causes of maternal deaths in the facility.AIM: This study was aimed at determining the trend in maternal mortality in the same facility, following institution of some facility-based intervention measures.METHODOLOGY: A retrospective study design was utilised with extraction and review of medical records of pregnancy-related deaths in UCTH, Calabar, from January 2010 to December 2014. The beginning of the review period coincided with the period the “Woman Intervention Trial†was set up to reduce maternal mortality in the facility. This trial consists of the use of Tranexamic acid for prevention of post-partum haemorrhage, as well as more proactive attendance to parturition.RESULTS: There were 13,605 live births and sixty-one (61) pregnancy-related deaths in UCTH during the study period. This yielded a facility Maternal Mortality Ratio of 448 per 100,000 live births. In the previous 11-year period of review, there was sustained the decline in MMR by 72.9% in the initial four years (from 793 in 2010 to 215 in 2013), with the onset of resurgence to 366 in the last year (2014). Mean age at maternal death was 27 ± 6.5 years, with most subjects (45, 73.8%) being within 20-34 years age group. Forty-eight (78.7%) were married, 26 (42.6%) were unemployed, and 33 (55.7%) had at least secondary level of education. Septic abortion (13, 21.3%) and hypertensive diseases of pregnancy (10, 16.4%) were the leading causes of death. Over three quarters (47, 77.0%) had not received care from any health facility. Most deaths (46, 75.5%) occurred between 24 and 97 hours of admission.CONCLUSION: Compared with previous trends, there has been a significant improvement in maternal mortality ratio in the study setting. There is also a significant change in the leading cause of maternal deaths, with septic abortion and hypertensive disease of pregnancy now replacing post-partum haemorrhage and puerperal sepsis that was previously reported. This success may be attributable to the institution of the Woman trial intervention which is still ongoing in other parts of the world. There is, however, need to sustain effort at a further reduction in MMR towards the attainment of set sustainable development goals (SDGs), through improvement in the provision of maternal health services in low-income countries